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Date run 6/23/2022 3:04:52PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/23/2022 <br /> Record Selection Criteria: Facility ID FA0021678 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <br /> Owner ID OW0005707 New Owner ID <br /> Owner Name LINCOLN CENTER ENVIRONMENTAL REME <br /> Owner DBA <br /> OwnerAddress 3043 GOLD CANAL DR 100 <br /> RANCHO CORDOVA, CA 95670 <br /> Work/Business Phone Not Specified <br /> Alternative Phone Not Specified <br /> Mailing Address 3043 GOLD CANAL DR STE 100 <br /> RANCHO CORDOVA, CA 95670 <br /> Care of NILAND, JOSEPH <br /> FACILITY FILE INFORMATION APN 09741079 <br /> Facility ID/CERS ID FA0021678 <br /> Facility Name LINCOLN CENTER ENVIRONMENTAL REME <br /> Location 6475 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 916-637-8325 <br /> Mailing Address 3043 GOLD CANAL DR STE 100 <br /> RANCHO CORDOVA, CA 95670 <br /> Care of NILAND, JOSEPH <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOE NILAND, TRUSTEE <br /> Title <br /> Day Phone 209-478-9200 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039324 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GEOSYNTEC CONSULTANTS INC (CirdeOne) <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 6/23/2022: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0537637 EE0001699-JOHNNY YOAKUM Active Y N A/ I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number ' _ Received b t <br /> EHD Staff: ! Date _/ ! Account out: Date--L—/-9/27 <br /> COMMENTS: <br /> Invoice#: <br />